Evidence tabel stadiering

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1 Evidence tabel stadiering Auteurs, T stage Syst Reviews Kwee, 2007 Systematic review Studies included up to aug 2006 Kelly, 2001 Systematic review Studies included from steekproefgrootte) Included were: studies investigating diagnostic accuracy of, or MRI for T with newly diagnosed, histologically proven cancer. Included were: studies investigating the use of for in a of gastrooesophageal carcinoma on human subjects, comparison with the gold standard reference test of pathology. Excluded were: Non-English studies, studies only evaluating early or adced, Excluded were: studies including <10 patients, studies that did not supply sufficient information to construct a 2x2 contingency table Indextest Referentie-test Resultaten Conclusie Opmerkingen : 22 studies : 5 studies MRI: 3 studies /: 1 Endoscopic ultrasound () 27 articles included; 13 on carcinoma s Pathological examination after surgery Pathology The studies were of moderate methodological quality. Diagnostic accuracy of overall T for,, and MRI varied between 65% to 92.1%, 77.1% to 88.9%, and 71.4% to 82.6%, respectively. Sensitivity for assessing serosal involvement for,, and MRI varied between 77.8% to 100%, 82.8% to 100%, and 89.5% to 93.1%, respectively. Specificity for assessing serosal involvement for,, and MRI varied between 67.9% to 100%, 80% to 96.8%, and 91.4% to 100%, respectively. Ranges of sensitivity and specificity in included papers: Sens: (T1/T2 correctly staged) range % Spec (T3/ correctly staged) range % Q = 0.93 (95%CI 0.91, 0.95) Q=optimum performance (balances sensitivity and specificity). The higher the Q, the better the performance of Q lymph node 0.79 (95% CI 0.75, 0.83). This refers to cancers combined. It is stated that there is no difference in performance in and esophageal regions but no data are presented.,, and MRI achieve similar results in terms of diagnostic accuracy in T and in assessing serosal involvement. Most experience has been gained with. is highly discrimination of stages T1 and T2 from stages T3 and is less lymph node Goede review, studies matige kwaliteit resultaten niet gepoold maar range de studies is weergegeven Review geupdate in 1999 met medline search

2 Auteurs, Syst review Kelly, 2001 Comparative studies Meining, 2003 Germany Systematic review Studies included from Retrospective Steekproefgrootte) Included were: studies investigating the use of for in a of gastrooesophageal carcinoma on human subjects, comparison with the gold standard reference test of pathology. 108 patients, of which 53 with tumors of the stomach Excluded were: studies including <10 patients, studies that did not supply sufficient information to construct a 2x2 contingency table Not reported All patients had undergone complete tumor resection Indextest (diagn. Onderzoek) Endoscopic ultrasound () 27 articles included; 13 on carcinoma s Controle (referentie-test) Pathology Histopathological findings Resultaat Conclusie Opmerkingen Ranges of sensitivity and specificity in included papers: Sens: (T1/T2 correctly staged) range % Spec (T3/ correctly staged) range % Q = 0.93 (95%CI 0.91, 0.95) Q=optimum performance (balances sensitivity and specificity). The higher the Q, the better the performance of Q lymph node 0.79 (95% CI 0.75, 0.83). This refers to cancers combined. It is stated that there is no difference in performance in and esophageal regions but no data are presented. Mean (SD) accuracy rates for (n=53) across 5 investigators: T-stage 41.1 (9.4) N-stage 47.9 (5.1) Kappa values for T stages ranged between 0.34 and 0.47 and for s 0.29 and 0.46 is highly discrimination of stages T1 and T2 from stages T3 and is less lymph node The accuracy of under strictly blinded conditions is low Review geupdate in 1999 met medline search linded but small sample size; Javaid, 2004 India 112 patients with without evidence of metastasis to liver or peritoneum Mean 55.6 yrs (range 35-75); 54% males Histological (following recommendations AJC on of cancer) Overall T : accuracy 83.0%; sensitivity 80%; specificity 90.0% Overall N : accuracy 64.2%; sensitivity 67.2%; specificity 89.0% Accuracy per stage T1 77.7% (7/9) T2 86.9% (20/23) T3 83.7% (36/43) 81.0% (30/37) is quite accurate for T- and N0. However, it is considerably decreased for and stages. sampling and blinding not N0 87.5% (28/32) 61.5% (16/26) 33.3% (18/54) entrem, Retrospective All patients who Not reported Pathology T-stage prediction is more Retrospective

3 2007 US underwent a clinical assessment of T/ with and subsequent R0 resection for adenocarcinoma (n=225) 124 had tumours involving the proximal third/gastroesop hageal junction Accuracy individual T stages: 127/223 (57%) Accuracy determining serosal invasion (T1/2 vs t3/4): 164/223 (74%); sensitivity 88%, specificity 66% N-stage prediction Accuracy individual s: 110/218 (50%) Accuracy determining nodal positivity (N0 vs N+): 154/218 (71%), sensitivity 75%, specificity 66% sensitive than specific for serosal invasion or nodal disease. Shinohara, 2005 CT Japan Kim, 2005 Korea A2 A2 278 consecutive patients with adenoma showing invasion within either mucosal or submucosal tissue confirmed by endoscopic biopsy 124 consecutive patients with (106 included: EGC 45, AGC 61) Mean age 60 yrs Mean age 56 yrs (range 28-76); 70% males and operative assessment 3 different slice thicknesses 2.5 mm (n=57) 5.0 mm (n=188) 7.5 mm (n=33) Transverse Volumetric Histological nodal findings Pathology using endoscopic biopsy Overall accuracy N (N0-3) ; 86% (95% CI 82-90%) operative assessment: 95% (95% CI 92-97%) Accuracy* 91% (81-97%**) 86% (80-91%) 88% (72-97%) * discriminating presence lymph node metastasis Sens* 80% (28-99%) 46% (19-75%) 0 **assumed these intervals are 95% CI Spec* 92% (81-97%) 89% (84-93%) 94% (79-99%) Overall accuracy of tumor for transverse CT was 77% and for volumetric CT 84%. Differentiation between T1/2 versus T3/4 was correct in 87% (80/92) at transverse CT and 92% (96/104) at volumetric CT. Overall accuracy of lymph node for transverse CT was 62% (66/102) and for volumetric CT 64% (68/106). represent a valuable diagnostic tool to detect lymphe node metastasis of EGC Volumetric CT compared with transverse CT can improve the accuracy of of. Not all patients had all tests lackshaw, 2005 CT UK 100 patients with histological diagnosis of adenocarcinoma Median age 70 yrs (range 27 to 86) Helical CT or Multislice CT Histopathology Overall accuracy of of metastases was 86% (6/7) for both transversal and volumetric CT Relative accuracy hct (n=72) T N M (liver) M (peritoneal) mct (n=28) T N M (liver) Sens 63% 63% 45% 6% 69% 89% 80% Spec 83% 39% 90% 100% 87% 78% 91% With progressive improvements in CT technology, the role of CT in of is becoming stronger size

4 M (peritoneal) 25% 100% Smaller comparative studies ( patients) Agreement (kappa) between observers hct: 0.28 (95% CI 0.14, 0.41) mct: 0.53 (95% CI 0.30, 0.76) Agreement between assessors improved from the first to the last quartile of patients Yun, 2005 PET and CT Korea Retrospective 81 patients with (17 early and 64 adced) Mean age 56.6 yrs (range 32-82) All underwent radical or palliative gastrectomy and lymph node dissection 18 F-FDG PET CT (Persijn Meerten / Craanen: check artikel om te bepalen of dit hct of is) Histopathology Primary tumors: sensitivity 47% (8/17) for EGC and 98% (63/64) for AGC sens 34% (18/53) 34% (11/32 50% (3/6) spec 96% (27/28) 96% (47/49) 99% (74/75) Primary tumors: sensitivity 47% (8/17) for EGC and 98% (63/64) for AGC sens 58% (31/53) 44% (14/32 50% (3/6) spec 89% (25/28) 86% (42/49) 99% (74/75) Despite its high specificity, PET was less sensitive than CT for the detection of disease. oth modalities have low sensitivity for and disease. size Mochiki, 2004 PET and CT Japan 85 patients with Median age 63.2 yrs (range 36-85); 60% males Patients undergone surgical treatment for with curative intent 18 F-FDG PET Pathologic T + sens *75.2% (64/85) T3 en tumors were detected more frequently than T1 tumors (P<0.01) 23.3% (14/40) 17.6% (3/17) 42.1% (8/19) 75.0% (3/4) Spec % 100.0% FDG-PET was successful but not for finding early-stage cancers. Detection of nodal metastasis was not possible by FDG-PET. size; CT 65.0% (26/40) 58.8% (10/17) 63.1% (12/19) 100.0% (4/4) 77.0%

5 Auteurs, M-stage Comparative studies De Graaf, 2007 Laparascop y UK lackshaw, 2003 and CT UK Retrospective steekproefgrootte) 416 patients with eosopha cancer; 109 had 100 patients with adced adenocarcinoma (T3 or 4, or 2 and equivocal M1) Median age 68 yrs (range 30-87); 74% males Median age 70 yrs (range 35-86); 59% males Indextest (diagn. onderzoek) Laparascopy Spiral CT Controle (referentie-test) CT and/or ultrasound Histopathological Resultaten Conclusie Opmerkingen Staging laparascopy resulted in a change in treatment decision of 28.0% (36/109). In these cases laparascopy avoided unnecessary laparotomy. These patients had extensive locally invasive disease or presence of intraperitoneal or liver metastasis T1/2 T3 M1 M1 (peritoneal) M1 (liver) T1/2 T3 M1 M1 (peritoneal) M1 (liver) Sens Sens Spec Spec Staging laparascopy was most useful in adenocarcino ma, distal oesophageal, GOJ and gastrc cancers oth CT and laparoscopy agreed with histopathologi cal. held an adtage over CT in assessing the presence of peritoneal metastases. No gold standard used Kim, 2005 Korea A2 124 consecutive patients with (106 were included: EGC 45, AGC 61 Mean age 56 yrs (range 28-76); 70% males (transverse and volumetric) Pathology using endoscopic biopsy Overall accuracy of tumor for transverse CT was 77% and for volumetric CT 84%. Differentiation between T1/2 versus T3/4 was correct in 87% (80/92) at transverse CT and 92% (96/104) at volumetric CT. Overall accuracy of lymph node for transverse CT was 62% (66/102) and for volumetric CT 64% (68/106). Volumetric CT compared with transverse CT can improve the accuracy of of. Kayaalp, 2002 CT and US 118 patients with various types of Mean age 61 yrs (range 38-78); 63% males Overall accuracy of of metastases was 86% (6/7) for both transversal and volumetric CT Spiral CT Surgical findings Metastasis Acc Sens Spec Liver 91% 62% 99% Peritoneal 82% 13% 99% Retroperitoneal 79% 41% 85% oth techniques allowed more accurate identification

6 Turkey US Liver 87% 50% 98% identification Peritoneal 81% 9% 98% of liver Retroperitoneal 83% 18% 94% metastases than peritoneal and retroperitoneal invasion. Auteurs, Overall TNM Comparative studies Kaiser, 2007 Germany steekproefgrootte) 125 patients with potentially resectable cancer of the distal esophagus or cancer. Of these, 55 had. Median age 60 yrs (range 25-73); 67% males Indextest (diagn. onderzoek) Staging laparoscopy and cytology Controle (referentie-test) Conventional (abdominal US and CT) Resultaten Conclusie Opmerkingen Results refer to subgroup of (n=55) Peritoneal seeding (n=11), tumor involvement of regional lymph nodes (n=3), metastatic liver disease (n=2) or Krukenberg s tumor (n=1) were first detected during laparoscopy and not during conventional. Laparascopy changed tumor classification in 19 cases (down in 2 and up in 17 cases) Laparotomy or thoraco-abdominal exploration could be avoided in 14 patients with. An additional 3 had already suspected distant metastatic disease by conventional, confirmed by laparascopy. There was no laparoscopy-related morbidity. is a safe and effective modality, avoiding unnecessary laparotomies. size; no gold standard used